PLANNING YOUR NEXT REVISION: STEP BY STEP

Understand the nature of the problem. Revision TKR is a major undertaking and should be focused on problem solving. Know the problem!- Pain is not a diagnosis. Review history of problem. Think of possibilities: Infection, loosening, instability, stiffness, malalignment, poor kinematics.Ensure an adequate workup - History, Exam; Imaging: Radiographs: consider long alignment films, MR for soft tissue issues: Clunk, recurrent hemarthroses; CT scan: Remains gold standard for rotational alignment. Labs: CBC, ESR, C-reactive protein. Aspiration: Cell count, Culture.Assessment of where the patient is currently!Synthesise a working diagnosis and formulate a provisional plan. Revise “part of knee”: you better know what's in there! Revise “all of knee”.How will you get there? Think old incisionsHow will get the parts out? What tools do you need? High speed burrs / diamond tip wheel /long thin saw blades; Osteotomes; Implant specific tools.Once everything is out: What do you have left? Soft tissue defects, Bone defe...